The Ashbourne College Medical School Programme has been running for more than 30 years since the college was established in 1981. It is designed to give students the best possible chance of entering a UK medical school.
This section provides information about what Ashbourne College has to offer to its medical candidates and guidance for students on how to prepare themselves to apply to read medical degrees.
It also contains some important information about entry requirements to medical degrees for both first-time and retake applicants.
What you need to do
Prospective medical applicants need to:
- Achieve high academic results;
- Have gained suitable work experience;
- Demonstrate good communication skills at interview to reflect how you would deal with patients;
- Be well-rounded individuals (have hobbies and interests);
- Have researched the profession and be well-informed of issues within medicine;
- Have a genuine ambition and determination to become a medical practitioner.
How we can help
- Discussion of medical issues in class;
- Advice on medical schools and the applications procedure;
- Guidance through the UCAS process;
- Regular scheduled workshops;
- Mock BMAT/UKCAT tests;
- Practice interviews.
Medicine is a five/six year course studied at university and in hospitals that qualifies you to become a doctor. ‘Doctor’ is a broad term encompassing many careers including GP (general practitioner), surgeon and specialist (e.g. pathologist or anaesthetist).
Completing a degree in medicine is the only way to legally become a doctor in the UK. Be aware that many courses offered do not do this and are purely science degrees (e.g. medical sciences, biomedical sciences and clinical sciences).
A rewarding and varied career
Medicine is a rewarding and varied career. You will cover subjects as wide-ranging as broken bones, skin conditions, mental illness, open-heart surgery, pregnancy and post-mortems.
It is also very demanding and challenging and you need to be 100 percent sure that this is the career for you before embarking upon the course. You will be required to make important decisions and the way you interact with people can have a major impact on people’s lives.
Although most doctors work for the NHS, there are opportunities in other establishments such as the armed forces, prisons or with the Home Office working as a police surgeon.
Medicine, Dentistry and Veterinary Science
Medicine, Dentistry and Veterinary Science are perceived as among the most challenging choices of study at university.
The workload is very demanding with continuous rounds of assessment. A doctor needs to be committed to lifelong learning and study as the field is constantly changing; another set of tests or exams are always around the corner at all levels.
Getting into medical school
Entry into medical school is not based on solid academic achievement alone. Students need to be well prepared and well informed about issues in medicine, be comfortable in the interview, gain suitable work experience and have a genuine and strong ambition to become a doctor.
Medicine is also emotionally and spiritually demanding and skills such as interacting with patients and managing extremely stressful and distressing situations are essential to becoming a successful doctor.
Rewards and costs of a medical career
Doctors are generally well paid and their working hours have improved in recent years; however, students should be aware that due to the length of the course they may amass substantial debts while at medical school as a result of tuition fees, living expenses and the purchase of books and equipment.
Every year King’s College, London receives around 4,500 applications for 410 places at their medical school.
Competition is tough and you must be outstanding to get an offer!
What Ashbourne offers
Firstly, you must remember there are no guarantees. Most people who apply to medical schools will not obtain a place. Competition is fierce.
However, Ashbourne’s record of students gaining offers is considerably higher than the national average, and we pride ourselves on the quality of assistance we provide to potential medical candidates and to the UCAS procedure in general.
Excellent predicted A level grades on the UCAS application are essential. This is particularly important for overseas candidates who may not have sat GCSE or equivalent examinations; for such candidates, the AS grades will be the only graded external examination qualifications on the UCAS form.
Although retakes may be an option, all medical candidates should look to achieve solid AS grades at the first attempt.
In addition, subjects taken only to AS level can contribute to your overall scores and are essential for admission to some of the most competitive courses, particularly when only three subjects are taken to A level.
You can expect:
- To receive 6 hours of tuition per subject per week in the lower sixth. This will continue into the upper sixth; however, an additional 2 hours per subject per week will be provided where necessary to provide support to any students who need to retake papers in their second year. (One year intensive students can expect to have 6–8 hours tuition in each subject per week);
- Class sizes that rarely exceed 10 students;
- Enthusiastic teachers who will take an interest in your studies and your application to medicine, and appreciate your specific needs and requirements. Your tutors will always put your best interests first and will be on hand to offer assistance outside of class whenever they have no other teaching commitments;
- Medical seminars on topical medical and scientific issues using up-to-date materials and journals;
- Visiting speakers and guest lecturers throughout the year;
- The opportunity to attend external medical lectures and seminars. Ashbourne is well situated for such events and they are organised regularly; Imperial College Medical School is a 10-minute walk and University College, London is a 20-minute tube ride. Medical applicants are urged to attend these events to broaden their interests and keep up-to-date with current medical and scientific issues.
You can expect:
- A personal tutor to guide you through every step of the application process
- One-to-one assistance with your application and personal statement where appropriate
- Mock interviews with senior, highly experienced Ashbourne staff including Ashbourne’s Head of Medical School Programme Amy Harper-Tarr, who is also a member of the UCL Medical School interview panel.
- A fair and thoughtful personalised reference for the UCAS form and for any work experience.
Students usually find the interview the most daunting part of the application process. You will be cross-examined by a panel of experts and there is pressure on you to perform and give the best impression of yourself in just 15–30 minutes.
Ashbourne students will gain invaluable interview practice with Amy Harper-Tarr, Head of Medical School Programme and member of the UCL Medical School interview panel. Plus further mock interviews with Christopher Masters and Will Stockard, Oxbridge and Russell Group university admissions and UCAS advisers.
All of our former medical candidates described the mock interviews as invaluable for building confidence and picking up vital tips before the real thing.
What if there are problems with my application?
Your personal tutor will check your application before it is submitted to ensure that it is free from errors. However, other problems may arise after your application has been sent.
There are, for instance, occasionally technicalities that overseas students need to ensure they have completed before they are offered a place. You will be responsible for this yourself; however, your personal tutor will assist you in any way he or she can and you can expect them to be committed to ensuring everything possible is done to ensure your application runs smoothly.
Ashbourne will not find work experience for you; however, we will assist wherever we can in recommending places and people to contact and by giving guidance as to the appropriate types of work experience to look for.
We will also assist by giving references where necessary. Ultimately, however, work experience should be organised by the student as this demonstrates a committed and pro-active attitude during your application.
Medical course options
A standard medical course is five years. After successfully completing the course you graduate as a Bachelor of Medicine and Surgery (usually MBChB).
Some universities offer a six-year course to students who are academically suitable to study medicine but have not completed the correct subjects at A level.
These ‘Foundation’ courses provide a pre-medical year learning the scientific background required to continue onto the standard course.
Typical course structure
Medical courses are structured in two parts: pre-clinical and clinical. Pre-clinical coursework includes academic and theoretical learning and the science of the human body. It takes place in lectures and tutorials.
The clinical part of a medical course focuses primarily on the practical: applying the knowledge you have gained in realistic doctor–patient scenarios. The clinical part takes place in a teaching hospital.
Balancing pre-clinical and clinical work
The way the pre-clinical and clinical parts of the course are integrated depends on the medical school. At some universities you will study the background theory in lecture-based format for up to three years before you go anywhere near a hospital or patients (e.g. Cambridge University).
Other universities offer a more integrated course where you come into contact with patients virtually straight away (e.g. Newcastle University).
Traditional versus problem-based learning (PBL)
Both types of courses have their merits and disadvantages. PBL courses have been criticised for the lack of interaction between the students and tutors. Traditional courses, however, have been criticised for ‘spoon-feeding’ students and failing to develop their ability to cope in the real world.
PBL courses are offered at Liverpool, Manchester, Glasgow, Bart’s, Peninsula, Sheffield, Keele, Hull–York and East Anglia.
Traditional courses are now pretty rare and the only universities still teaching in this way are Oxford, Cambridge and St. Andrews.
There is a distinctive pre-clinical/clinical divide and the pre-clinical years are taught rigidly in subjects. In some of these universities you have to apply again for the clinical course; for example, at St. Andrews they only teach the pre-clinical course and you have to move somewhere else (often Manchester) for the clinical years.
This type of course suits the scientifically minded student as you can lose motivation due to the lack of patient contact in the first few years. This type of degree offers more scope for academic reading and is generally taught mostly in lectures and tutorials.
The majority of UK schools use systems-based teaching (e.g. Birmingham and Leeds). Seeing the direct uses of the information can enhance student motivation. It does, however, leave the student to make important links between systems using their own initiative.
Many of these courses claim to have patient contact from day one but this varies from place to place and may just be local community visits.
The amount of patient contact increases from year to year and there is still a slight divide between the pre-clinical and clinical years. The type of teaching on these courses is through a mixture of lectures, tutorials and self-directed learning.
At some universities the course is ‘intercalated’ and lasts for six years. In these courses an extra degree is earned alongside the medical degree – usually a BSc. This gives the student an opportunity to gain a further qualification and also broadens their research and individual study skills.
Usually you gain this qualification after your third year. Some universities give the student a choice of speciality, some have a common curriculum and some offer the intercalated part of the course as an option.
Medical schools with compulsory intercalated courses are: Imperial, Cambridge, Oxford, UCL and Bute (St. Andrews). People may choose an intercalated course to extend their knowledge of a specific subject and it may confer an advantage in some competitive fields of medicine; it does, however, lengthen an already long degree course.
Student Selected Components (SSCs/SSMs/SSUs)
The General Medical Council (GMC) decided that five years was too short a time to teach the whole of medicine and so identified a ‘core curriculum’ that all medical schools should follow.
SSCs are a way in which students are able to learn topics that are not in the core. They form up to 25–30% of the course at some universities and are a range of diverse projects chosen by the student where they can study a specific subject in depth.
The emphasis is on self-directed learning and developing new skills. Projects can range from sports medicine to foreign languages to aromatherapy.
This is an opportunity to practise medicine anywhere in the world for two months during your clinical years.
Electives range from running outreach clinics in developing countries to accompanying flying doctors in Australia. You may wish to spend time working on a research project (there is often funding for this). Some students find time to travel for a few weeks after their elective. In general, however, the elective is self-funded so many students prefer to remain in the UK.
Other factors to consider
Other factors you may wish to take into account when choosing which medical school to apply to are:
- Location – city vs campus based. Do you like the city? (You will be there for at least five years)
- Entry requirements – typical grades and retake policy
- Reputation – league tables / talking to students
- Specialist – medical school vs large, multi-disciplinary university
- Facilities – accommodation / social aspect / extra-curricular.
If you cannot decide where to live you could consider St. Andrews University, Scotland. You will study there for a three year BSc course before transferring to complete your medical degree in Manchester. That way you will get to experience two fabulous and historic universities as well as live in two different countries.
It is often a good idea to go and look around a few universities by attending their open days to get a feel for the atmosphere and talk to some of the students on the medical course. If you miss the open day you can still make a visit to have a look around the city and meet some students.
The entry requirements for each medical school are slightly different – you need to make sure that you have the correct subjects for the schools you want to apply to – see Entry requirements. Each year the criteria get tougher and tougher; realistically, if you are not capable of getting straight A grades at A level, then you should not really be applying to medical school.
Remember, these are minimum requirements. Good candidates will be capable of exceeding these comfortably.
After completing your medical degree you take a two-year Foundation Programme followed by training either as a GP (currently three years) or in a specialty (five to eight years).
Bridging university and specialist training
On completing medical school, junior doctors enter a vocational training phase. Newly qualified doctors apply for a place on a two-year Foundation Programme. This is a bridge between university and specialist training.
It consists of a series of placements in a variety of healthcare specialities to give you a broad insight into the different areas of medicine and enable you to decide the specific area on which you wish to focus.
Foundation House Officers
During the Foundation Programme doctors are called ‘Foundation House Officers’ (FHO1 and FHO2). This replaces the traditional grades of Pre-registration House Officer (PRHO) and Senior House Officer (SHO).
During the first year, students only hold provisional registration with the General Medical Council – full registration is granted on completion of the first year. Students rotate through 3/4 jobs in different hospital specialities.
The GMC specifies that these must include General Medicine and General Surgery (General Practice is not allowed).
The focus of the second year is the assessment and treatment of the acutely ill patient and also encompasses generic skills such as teamwork, time management, communication and IT skills.
Achieving your Certificate of Completion of Training (CCT)
Following the Foundation Programme is a training period known as Speciality Registrar (StR). This involves structured specialist or general practitioner training programmes and leads to the award of a Certificate of Completion of Training.
To become a GP you must spend three years as a Speciality Registrar; for a hospital speciality, you carry out six years of training before qualifying as a Consultant.
Previously doctors were required to take the relevant Medical Royal College membership examinations whilst still an SHO, but under the new system the exams are taken later on during year 1/2 of the Speciality Registrar Training Scheme.
You are advised to keep up-to-date with changes on training and career paths in medicine by reading the national press and periodically reviewing the websites below:
Royal Colleges provide education and training to post-graduate medics.
- College of Emergency Medicine (accident and emergency/trauma)
- Royal College of Anaesthetics (anaesthesia/pain management)
- Royal College of General Practitioners (GP)
- Royal College of Obstetricians and Gynaecologists (sexual and reproductive health)
- Royal College of Ophthalmologists (eye disease)
- Royal College of Pathologists (diagnosis of disease)
- Royal College of Paediatrics and Child Health (child health)
- Royal College of Psychiatrists (mental health)
- Royal College of Radiologists (medical imaging)
- Various colleges of physicians and surgeons depending on location.
More importantly – do you want to be a doctor? If you have the desire to achieve, then you can build up the skills required to gain a place at medical school and become a good doctor.
If you have thought carefully about what the training and career entails and you think this is the career for you, then go for it. You do, however, need to address the following key skills and check whether you can demonstrate these in your activities or whether you need to work on developing them.
Your academic skills will be assessed on the basis of your A level results. Your aptitude to study medicine and evidence of numerical and reasoning skills will be judged through medical school admissions tests BMAT or UKCAT (outlined below in How to apply).
There are a lot of ‘soft’ skills that are required which will be tested through your UCAS form and interview:
- Integrity – veracity and honesty. You will be responsible for personal and sensitive information. You must adhere carefully to codes of conduct and base your actions on a strict set of values. You must also be loyal to your patients and colleagues;
- Communication – both with patients and other doctors, written and oral. Listening is often as important as talking;
- Interactive – you will need to be able to work effectively in a team, get along with people, and liaise with individuals and groups;
- Flexible/proactive – you will often be in a highly pressurised environment, so you need to have the initiative to think on your feet and come up with swift solutions to new problems;
- Tenacity/determination – the career path for a doctor is long and scattered with obstacles. There are exams, tests and interviews all the way through and competition is fierce. You need to be undeterred by these challenges and continue to work hard to achieve the final goal;
- Commitment – not only is the course itself long, but at times you will work long hours for little return and the job will be emotionally and physically exhausting. You need to be self-motivated and enthusiastic enough to make it through the hardest times. Resilience is a key attribute;
- Enquiring mind – medicine is a fast-moving field and you will need to keep on top of new discoveries and developments. Sometimes there is no correct answer to problems and you may need to challenge some of the evidence put before you;
- Compassion – at the end of the day, medicine is about caring for the welfare of others. Often it is advice and reassurance that are required rather than a specific drug or treatment. You often need to be sympathetic and sensitive to both patients and relatives as you may be a key source of support at a very emotional time. Empathy is important, as is a non-judgmental attitude;
- Scientific approach – you need to be methodical in your assessment of problems. Medicine is all about assessing symptoms, diagnosing illness, testing your prediction, devising a treatment and then monitoring its progress;
- Leadership skills – a senior doctor may run a department that will involve managing other doctors/support staff as well as time and financial management. You will need to be self-motivated and confident. Even if a candidate does not exhibit leadership skills now, they must have the potential to be successful in a leadership role;
- Position of responsibility – you will need to make important decisions that will impact the lives of others. You will need to remain calm and focused throughout stressful and pressurised situations;
- Breadth of interests – you should have a range of hobbies and demonstrate that you have other interests besides medicine. It is important that you know how to escape from work and relax in your spare time; otherwise, you may not last long in the profession;
- Stamina – you must be able to deal effectively with stress and not let pressurised situations affect your judgement or ability to carry out your duties;
- Limitations – no one is perfect and it is important that you can reflect on your strengths and weaknesses in order to develop yourself and work to your greatest skills;
- A sense of humour – this may also be key – especially as a junior doctor!
Most of those soft skills are tested in the interview. Two thirds of universities now used the Multiple Mini Interview (MMI) rather than a traditional panel interview. The MMI format uses short independent assessments, called ‘stations’, as part of a timed circuit. A 45-minute interview can therefore be divided into nine mini-interviews of 5 minutes each. The candidate moves from station to station, usually room to room or table to table, and is asked a question targeting soft skills and logical thinking, and must answer in the imparted time. Whatever the outcome the candidate moves to the next station and starts afresh each time, so even if you stumble on one question not everything is lost! All the scoring is then added in the end to make up an overall assessment of the candidate’s performance. This type of interview has been shown to be fairer, as it targets particular soft skills more and is also a social equaliser as it does not advantage the perhaps more eloquent public school students.
Being a doctor
Like all careers, there are positive and negative aspects to being a doctor.
It is not an easy decision whether to ‘bite the bullet’ and complete your medical school application. The challenges are stacked up in front of you and you need to be determined enough to face them.
Even if you are convinced you want to be a doctor, you should still gain as much insight and experience of the career as possible to give you the best chance of convincing a medical school that you would be a good candidate.
Sources of information and experience
There are lots of sources of information and experience that you should explore to prepare you for making your decision and then your application:
- Work experience/voluntary work
- Insight courses or conferences
- Websites and blogs
- Reading books and journals.
Work experience is a requirement for nearly all medical schools. As well as demonstrating commitment and motivation in your UCAS form and at interview, it is a good way of helping you decide whether medicine really is the career path for you.
You may be able to do some work ‘shadowing’ which will give you an insight into how the profession functions and what the day-to-day routine is like.
It is advisable to try to get experience of both primary and secondary care environments. If neither of these is possible, then some kind of voluntary work in a social care environment may be adequate.
Work experience ideas
- Phone your local NHS Trust – many of them have specific people employed to help find students work experience
- Speak to your GP – if they cannot give you any experience they may know of another surgery that can help
- Use existing contacts – friends, family who can put you in touch with a colleague
Contact your nearest medical school:
Work experience contacts
- Imperial College Healthcare Trust (including St Mary’s Hospital, Charing Cross) – call 020 313 4120 or email.
- Chelsea & Westminster Hospital offer short term work observation placements shadowing doctors, nurses, therapists and other healthcare professionals or non-clinical staff. This may include ward visits, outpatient clinics and multidisciplinary meetings. To enquire or apply email. For longer term volunteering opportunities call 020 3315 6864.
- Voluntary Services Department at University College London Hospital – contact 020 3447 9828 or email. Also view UCL medical school guide to volunteering(pdf).
- St John’s Hospice call 020 7806 4049 or email. Voluntary work with St John’s requires a minimum commitment of six months.
- Royal National Orthopaedic Hospital offers limited work experience (forms available online) and volunteering opportunities; call 020 8909 5394 or email. Medical trainees and professional can also apply directly to specific departments: email.
- St Pancras Hospital volunteers must be over 18 years; no clinical positions. Call 020 3317 7146 or email. They do not offer work experience placements.
- Queen Mary’s Hospital, Roehampton is part of St George’s University Hospital Trust. Non-clinical volunteer opportunities available to over-18s living in the local area who can commit to three hours per week for six months. Find out how to apply.
- Ealing Hospital offers clinical work shadow placements to students aged 16–18 living or studying in Ealing, Brent and Harrow. Applicants must have predicted grades of Bs and above with supporting evidence from tutors. Applications accepted in May; placements in July. Application forms online or email. Longer term volunteering positions available to over-18s. Call 020 8869 2425/3065 or email.
Many of these trusts will only consider applicants who are able to commit to medium to long-term volunteering; this is because each student placed must have a DBS (criminal records) check, which can take 8–12 weeks to complete.
You may wish to discuss your time planning and academic commitments with your personal tutor and UCAS tutor.
Voluntary work is important even if there is no clinical contact whatsoever. It demonstrates commitment, a positive attitude and a level of communication. It also helps you to become aware of different social groups and their differing healthcare needs.
Most voluntary organisations are crying out for help (e.g. visiting old people’s homes, working in a youth centre). It is rewarding and helps develop some of the skills needed for a career in medicine; for example, hospice volunteering gives you a valuable insight into the emotional side of working with the terminally ill. You may also be able to volunteer in a counselling role with organisations such as ChildLine and the Samaritans.
Just gaining experience of a hospital environment can be invaluable, so getting a job as a hospital porter or support worker can be advantageous (look on NHS jobs website, in newspapers, at nursing agencies).
- One Westminster
- Do it
- National Council for Voluntary Organisations (NCVO)
- St John’s Ambulance volunteers
- Hospice UK
A taste of medical school
There are various courses run, usually by universities, which provide:
- An insight into life as a medical student and as a doctor
- Invaluable information to help you decide if medicine really is for you
- Preparation for parts of the application procedure.
One of the most intensive courses is the Medsim two-day practical workshop at Nottingham University where you can also benefit from lectures, seminars and advice on medical school applications.
There are also other courses and seminars that may be closer to home; various options are listed below:
- PreMed, email – presentations and interactive workshops;
- The Scientific Basis of Medicine – St George’s four-day taster medicine course for Year 12 students in July. Application Link;
- EPOC Conference: Improve Your Chances of Becoming a Doctor, call: 01707 661 107 or email. Cost is £89 (or £85 for bookings of three or more). This event will help you decide whether medicine is the career for you.
You will hear practical tips on getting into medical school and understand what admissions tutors, university selection committees and interview panels are looking for. You will get advice on improving your UCAS application and interview technique. You will also find out about the realities of daily life in the medical profession and speak to doctors and medical students about their experiences.
These courses will also help you to consider your alternatives: the academic options and alternative careers that are possible and will give you the chance to experience a university/medical school environment.
Students should also start broadening their reading. You may be asked about topical medical and scientific issues in an interview, so you should be up-to-date and well informed.
It is also recommended that you read some popular scientific books especially on more ethical or controversial issues. The following are a good place to start:
- Brave New World, Aldous Huxley
- The Selfish Gene, Richard Dawkins
- The God Delusion, Richard Dawkins
- Language of the Genes, Stephen Jones
- The Double Helix, Watson & Crick
- The Red Queen, Matt Ridley
- Bully for Brontosaurus, Stephen Jay Gould
- The Private Life of the Brain, Susan Greenfield
- The Man who Mistook his Wife for a Hat and other Clinical Tales, Oliver Sacks
- Suburban Shaman: Tales from Medicine’s Front Line, Cecil Helman
- What We Believe but Cannot Prove: Today’s Leading Thinkers on Science in the Age of Certainty, John Brockman.
How to apply to UK medical schools
All medical schools require Chemistry at A level and at least one other science; most require Biology to at least AS level. Check the entry requirements for the schools you are interested in.
A typical medical school candidate will offer Chemistry, Biology and Mathematics or Physics. A fourth subject to at least AS level is often a requirement and usually an advantage. Some schools like to see a more diverse fourth subject (e.g. a language or English), which demonstrates a breadth of interest and ability.
The minimum A level grade requirement is ABB with most schools accepting only AAB or AAA, and Cambridge currently requiring A*A*A. Medical schools generally give offers based on A level grades, not UCAS points (AAC would not substitute for an ABB offer, for example).
The GCSE requirements vary from one school to another (check the specific requirements). It goes without saying that you have to have a very strong academic background to be considered (i.e. mostly A* and A grades).
Students who do not have the ability to gain A grades at GCSE and A level will probably find the medicine course and career too challenging for them, and should be realistic about considering other alternative careers.
Most medical schools require you to pass an admissions exam such as UKCAT and BMAT (see Entry examinations below). For Oxbridge, you also need to fill in a specific entry form in addition to your UCAS form. Overseas students especially need to make sure that they read the university prospectuses very carefully to ensure that they meet all the specific entry requirements.
Medical school applicants will also be tested on their non-academic qualities and qualifications. Personal attributes required to become a successful doctor will be examined through the UCAS form and also usually at interview.
Medical applicants also need to demonstrate other interests outside the academic curriculum such as music and sports, which develop personal skills and make a more rounded individual. Teamwork and responsibility or leadership are key skills that need to be demonstrated through participation in school clubs, societies and social groups, for exmaple.
Ashbourne runs some excellent extra-curricular clubs and events including the annual Ashbourne Revue
Before a medical school candidate can be admitted to university, he or she must complete a Disclosure and Barring Service (DBS) check for previous convictions, and have been successfully vaccinated against Hepatitis B, which requires three doses. Some universities may require other vaccinations, so check their requirements.
The UCAS form
All applications to UK medical schools need to be made via the UCAS website in the same way as any other university applications. The UCAS applications open in mid-September.
You can apply to only four medical schools on your UCAS form. This leaves you an extra place on your form if you wish to apply for a different course e.g. biomedical science. Students are often worried about what to do with the extra place and it is something that you need to think seriously about. The medical school will not see the other courses you have applied for unless you apply for two courses at the same university.
Some people like to use the extra place as a backup in case they change their mind about doing medicine after applying. Note: You cannot apply for veterinary medicine or dentistry as your other option.
Backup options: Biomedical Science, Pharmacology, Immunology, Biological Sciences, Zoology and many more.
As medicine courses are so competitive, it is always a safe option to apply to an additional non-medical course to maximise your chances of getting a university offer. It is usually possible, if you do not receive any offers for medicine, to start a non-medical course at a university and then re-apply through a graduate-entry programme later on. Be aware that these courses, however, are often even more competitive to get onto.
Even if you are applying to a non-medical course, you should tailor your personal statement to medicine. Other degree programmes are aware that students apply to their courses as a backup to other degrees and are sympathetic to it.
The importance of a well-prepared UCAS form cannot be overemphasised. Writing the full form will take AT LEAST a month of work. In preparation, you need to obtain the originals of all examination qualification certificates, or good-quality photocopies, by the beginning of your final year. The final version is submitted online.
There are six sections on the form:
- Registration details: basic personal data such as date of birth and current address
- About you: further personal details such as nationality and fee code
- Your courses: you can only apply for four medicine-related courses
- Your education: details of schools, qualifications and grades
- Your employment history
- Personal statement.
Personal statement – standing out from the crowd
The personal statement on your UCAS form is your chance to convince the universities that you have thought carefully about a career in medicine and you are committed and motivated enough to make a good doctor. It is your opportunity to stand out from the crowd and the primary way in which a choice can be made between you and another equally suitable candidate.
Only 500 words are permitted, so it is imperative that you are as concise as possible and that everything you write is completely relevant. If you are interviewed, you may well be asked about material from your personal statement, so make sure that it is truthful and that you will be able to add to the information you have given on the form.
What you need to do
Explain why you wish to study medicine and the factors that influenced your decision. Think hard about what attracts you to medicine and avoid clichés (e.g. ‘I have always been fascinated by…’ and ‘Ever since I was a child…’). You should explain how your choice was a result of considered research and deliberation. If you cannot answer this question, should you really be applying?
Demonstrate your commitment to medicine by:
- Describing any work experience or voluntary work that you have done, what you learnt from it and how it helped you decide that medicine is right for you;
- Listing any conferences or courses you have been on and what you gained from them;
- Knowing your subject and being up-to-date – you need to demonstrate knowledge of topical issues in the field of medicine that interest you and why.
- Highlight the specific personal attributes you have that would make you a suitable candidate to be a doctor. You need to back these up with specific examples of achievements in a variety of areas like sport, music, hobbies and other interests. Medical schools want to see that you can work in a team and also hold a position of responsibility.
Want to follow in your parents’ footsteps?
Hobbies and interests are vital to your application for medicine to demonstrate that you are a well-rounded individual. People who are totally absorbed in their studies to the exclusion of all else will lack some of the personal attributes that are key to making a good doctor.
Do not just list or state achievements and attributes, you need to backup each statement with a specific example. Then be prepared to expand on these points in an interview. Commitment is really important and the medical school will want to know how long you have been pursuing your hobby, why you do it, what you gain from it and whether you have achieved anything.
Interests that involve groups, teamwork and communication are essential for demonstrating key skills for medicine.
Which sounds better?
“I have been playing the guitar for three months in my bedroom” or “I have played the trombone since I was nine, have passed grade 5 and play in the local band.”
Even if you are not musical or sporty, you can mention things like charity fundraising, the Ashbourne Revue, languages, photography, travel or web design, for example.
Your personal statement is exactly that – personal – and should be written by you, in your own personal style. No one else should be able to tell you the best way to write it, although it may be worthwhile looking at some examples to get an idea of the kind of content you should be including.
Example personal statements:
Your personal tutor will write your reference. A good reference needs to be earned and the tutors will be honest and frank. Personal tutors may contact previous schools to obtain further reference information. To earn a good reference is essential to be a good student. Ensure you are on time for lessons and with homework, which will avoid creating unnecessary work for your tutors. Participate with enthusiasm in classes, and be consistent in your approach to work.
Are you a good student?
In addition to sitting A levels, most medical schools require you to sit another entry exam specific to medicine.
UKCAT – UK Clinical Aptitude Test
The UKCAT tests mental ability, problem solving, logical reasoning, critical thinking and information management. It is designed so that medical schools can make a more informed decision about applicants and ensure that the candidates they select have the best combination of mental ability, aptitude and professional behaviour required for doctors to be successful in their clinical careers.
It does NOT have any science or curriculum content. So in theory it cannot be revised for, although it is possible to practise questions in order to become familiar with the format.
Most medical schools require you to sit the UKCAT. You must register for the test online between May and September and it can be taken at an external centre between July and October. It costs £65–100 depending on when and where you sit the exam; its lasts for two hours.
Ashbourne is a UKCAT centre – (there are around 150 test centres in the UK) – so you can take the test at the college. You get the results one–two months after you have taken the exam. UKCAT is entirely computer based and is does not test factual knowledge.
The UKCAT is only valid for one year. If your application to medical school is unsuccessful and you reapply the following year you must retake the UKCAT.
Universities not signed up to UKCAT include Birmingham, Cambridge, Imperial, Oxford and University College London.
The UKCAT tests a wide range of mental abilities and behavioural attributes identified by university medical and dental schools as important. The questions are all multiple-choice questions and the subsections are separately timed.
Remember that multiple-choice questions aim to give you the right answer plus several other answers that are almost correct but not quite. These are not trick questions but they require you to read all the options carefully. The paper is positively marked so put an answer for each question (do not leave any gaps). If you do not know the answer then eliminate any that are obviously wrong and then make a best guess. Pacing yourself is very important – note the time for each test and the number of questions.
There are five parts to the test:
There are practice questions available on the UKCAT website. This site is worth visiting to get an idea of the layout of the test, as it is computer based at the test centre.
There are also books of practice questions you can buy.
Practising aptitude tests
In addition to UKCAT-specific test questions available online and in books, you can also try other aptitude tests used in commercial recruitment processes that include verbal and quantitative reasoning tests similar to those in the UKCAT. There are also some places that use similar questionnaires to the non-cognitive analysis subtest, such as the Government’s Civil Service recruitment scheme.
The following websites may be useful as practice, but be aware that the UKCAT test itself is slightly different:
BMAT – Biomedical Admissions Test
The BMAT is a two-hour exam made up of three sections:
- Aptitude and skills (multiple choice and short answer questions) – 60 mins
- Scientific knowledge and applications (multiple choice and short answer questions) – 30 mins
- Writing task (short essay question) – 30 mins.
Ashbourne is a registered test centre for the BMAT. You receive the results by the start of December. The universities that require you to take the BMAT test are Cambridge, Imperial, Oxford, the Royal Veterinary College and University College London.
Everything you need to prepare for the BMAT is on the website.
There are also books you can use to help you get ready for the test, for example Preparing for the BMAT, John Butterworth & Dr. Geoff Thwaites, Cambridge Assessment, ISBN: 9780-435280130.
- Critical Thinking: An Introduction (Cambridge University Press) by A. Fisher
- Critical Thinking for Students by R. van den Brink-Budgen
- Thinking from A to Z by N. Warburton
- New Directions: Reading, Writing and Critical Thinking (Cambridge University Press) by P. Gardner.
The majority of medical schools interview the top candidates before offering places. These can take place anytime between November and April. It is important to prepare for these in advance and also practise giving answers to some of the more common questions out loud.
The structure varies from one medical school to another. One person or a panel of interviewers may interview you, and it may last 10 minutes or an hour. You may also have more than one interview.
Amy Harper-Tarr, Head of Ashbourne’s Medical School Programme and Faculty Head for Natural Sciences, is currently on the interview panel at UCL Medical School and can provide practice interviews and invaluable advice on the format and kind of questions asked.
Interviews are not designed as a form of torture! Interviews are a useful tool to determine if you are capable of making quick and rational decisions that you can explain clearly under pressure. They test your communication skills, enthusiasm and motivation. You should be able to demonstrate that you have thought a lot about medicine and the issues surrounding it.
What the interviewer wants to find out:
- who you are and what you are doing now
- why you want to be a doctor / how you made the decision
- what you have done to find out if medicine is the right career for you
- what you learned during your work experience
- what aspects of the course particularly appeal to you
- whether you have a realistic understanding of what a career in medicine involves
- what your other interests are
- whether you have good communication skills / enjoy working with other people
- whether you demonstrate an active interest in health/medical issues.
Why do you want to be a doctor?
Make sure that you have thought carefully about this and give an honest answer, not an answer that someone else has given you. Try to avoid clichés.
There will inevitably be some questions that you have not prepared for, but the important thing with these is to take your time in replying and think carefully before giving an answer. You should be honest and genuine and ask the interviewer to re-phrase the question if you do not fully understand what you are being asked.
You should read up on current health-related stories before you go for your interviews. They may ask you to talk about a specific current health topic of your choosing, so make sure that you know about one area in detail. You should think of the pros and cons of common ethical dilemmas such as abortion and euthanasia, for example, and be able to weigh up both sides of an argument.
Remember, you may get asked about information from your UCAS personal statement, so make sure that you can intelligently discuss anything that you claimed to have done or have an interest in. It is therefore very important never to cite an interest in the personal statement with which you are not very familiar. Make sure that you have looked at the website or the prospectus of the university that you are being interviewed at so you can talk knowledgeably about their specific course.
Examples of questions asked at medical school interviews:
- Why do you want to be a doctor?
- What alternatives have you explored? Why not be a nurse?
- What qualities do you think patients appreciate in a doctor?
- What qualities do you have that would make you a good doctor?
- What are your best/worst qualities?
- Why have you chosen this university? What do you think of our course structure?
- What are your views on public and private medicine and the government’s Foundation Hospitals?
- What is the difference between primary and hospital care?
- What is the National Health Service? What issues are currently predominant within the service?
- How do you see Britain’s healthcare system in 20 years’ time?
- What single healthcare intervention could change the health of the population the most?
- Will your personal/religious beliefs conflict with your duties as a doctor?
- What is an epidemic?
- Why are we so healthy compared to the Victorians?
- What is the difference between a virus and a bacterium? Against which are antibiotics effective and why?
- What is MRSA and how has it arisen?
- Why are SARS, avarian flu and ebola outbreaks so worrying?
- What is homeopathy? Do you approve?
- Do you think research is important? Why? What limitations are there to medical research?
- Tell me about something medically related that you have read in the press recently.
- Describe a situation you have been in which was stressful. How do you deal with stress?
- How would you deal with death and the dying?
- What do you think are the advantages/disadvantages of problem-based learning?
- What do you think you will find most difficult about a career in medicine?
- Tell me about your work experience. What did you learn from it?
- Research has shown that ‘integrity’ is an important quality in a doctor. What do you think is meant by this and can you give an example of a situation in which acting with integrity might be important?
- Give an example of when you have worked in a team.
- If complaints were made about you as a doctor how would you respond?
- Do you think that doctors need to ask for consent when taking organs from a dead person? What if it were only a blood sample?
- What have been the most significant advances in medicine in the last 10/20/30 years?
Make sure that you give a good impression by what you wear and the way you act. You must be smartly dressed and well presented; doctors are constantly in contact with the general public and appearance is important. You need to practise looking as professional as possible, so go for a safe option, nothing too outrageous!
You should prepare a couple of questions to ask at the end of the interview as usually the interviewer will ask if you have anything to ask them. Good questions are often ones relating to their specific course that show that you have researched their specific university well and have a genuine interest in their medical school.
However, do not feel that you have to ask a question if all your topics have been covered already. It is often safer to ask no questions at all than to show a lack of research or to repeat things already mentioned in the interview.
Thank the interviewer, smile and say goodbye before you leave the room. It always pays to leave a good impression.
What happens if I fail?
There are two stages at which you may not succeed in getting into medical school: you may not obtain the offer you want, or you hold an offer but do not gain the grades required to fulfil that offer.
It is important to remember that not getting a place at medical school can often simply be a reflection of medical schools in the UK being vastly oversubscribed, with competition for the limited number of spaces being very tough indeed.
Do you still want to study medicine?
Medical schools try to select the people that they think will make the best doctors and who have the correct ability and motivations for studying medicine, but even some students choose to leave mid-course and some will fail exams. The selection panel has a responsibility to make the right decision for the medical school, and you have a responsibility to yourself and to your potential future patients to make sure that you are making the right choice.
Examine your reasons for wanting to study medicine carefully. If in doubt, or if you have felt pushed in the direction of medicine, it may be better to look at alternative courses or careers (see below).
In this case, your choice in the fifth space on your UCAS form may provide a suitable alternative. It is worth researching this option so that you are well prepared to make a decision if you get no offers from medical schools.
Why was I not successful?
You may wish to approach the medical school that you applied to and ask for some constructive feedback. You may also consider reviewing your personal statement.
If you are convinced that medicine is the correct career for you and you want to persist in your applications, you have several options:
- Look into overseas medical schools that may still accept applications for the forthcoming year. These often accept candidates with slightly lower grades.
- Take a ‘year out’ and re-apply the following application round. This gives you time to polish your application: gain more work experience, re-write your personal statement, practise your interview technique etc. The extra time should be used constructively to boost your next application as you will need to convince a medical school that you are a better candidate than you were in your first application. If you are using the time to re-take some A level modules, you need to check which medical schools will accept this.
Be aware that if you reapply in later years, you must retake the UKCAT/BMAT as this is only valid for university entry in the year that you take the test.
Not obtaining the right grades
As a medical applicant, you will have been a high achiever academically, so your A level results are likely to be good even if they are insufficient to gain a place at medical school. If you have received an offer and your grades are only a few percentage points off those required and you are a strong candidate otherwise (extra-curricular, work experience, a good interview), it is worth discussing the issue with the admission tutor at the medical school in question.
If you did achieve good grades, it is worth contacting the medical schools you applied to, to see if they have unfilled places.
Clearing is another option, although it is rare for medical places to appear in clearing and you will almost certainly need to have applied before to the medical schools you contact.
You may have missed out on your A level grades the first time around and are hoping to improve your grades with a retake course. Fewer and fewer medical schools are accepting students with retakes. Some still do accept them and can view them as an indication of perseverance and dedication, but they will often ask for straight As in the retakes and may put a time limit on when they must be completed by.
Of the schools that do accept retakes, most will only do so if you already hold a conditional offer with them and have only missed out narrowly on the required grades.
Make sure that if you are retaking some A levels you only apply to those universities that are sympathetic towards retakes or else you will be wasting an application.
Where a university states that it will accept retakes only in ‘exceptional circumstances’, this usually means illness or bereavement, and you may need to show evidence of this (e.g. a letter from your GP).
If you are a retake student your chances of being offered a place are extremely small. You should think very carefully about your chances of success before you pursue this course of action.
It is your responsibility to check current entry criteria before you make your applications. Be aware that in general medical schools always prefer first-time candidates and so you cannot assume that retaking is a viable option. Discuss your options thoroughly with your tutor.
Medical schools in Ireland
There are seven medical schools in Ireland – one in Northern Ireland (QUB, which you apply to through UCAS) and six in the Republic of Ireland:
- University College Cork (UCC)
- National University of Ireland, Galway (NUI)
- Royal College of Surgeons in Ireland (RCSI)
- University College Dublin (UCD)
- The University of Dublin (Trinity College)
- University of Limerick (UL)
- Queen’s University Belfast (QUB).
Applying to an Irish university is not an easy option and most medical schools demand straight A grades. You will also be required to sit the HPAT entry test (see below).
One single payment allows you to apply for five medical school courses in Ireland in conjunction with UCAS. The Irish education system rests with the Department of Education and Skills. University tuition fees are currently free to all students from EU countries, however this may no longer be the case for British students once Britain leaves the EU.
Entry requirements need to be checked carefully as they are usually in point format, to fit with the Irish education system. Applications are generally made through the Central Applications Office (CAO) and can be made either online or via a paper application form by the 1st February (1st May for late applications).
Be aware that applications to Queen’s University Belfast are made through UCAS not through CAO.
Health Professionals Admission Test (HPAT)
Universities in Ireland now require you to take a test similar to the UKCAT called the HPAT. It is a 2.5-hour test focusing on:
- Logical reasoning & problem solving
- Interpersonal understanding
- Non-verbal reasoning.
Registration opens at the start of November and has to be taken at a test centre in Ireland in late February; check online for the exact dates as they change slightly each year. You must register for the test online by the 20th January. However, leave yourself plenty of time as there are things you will need to do in advance such as acquiring a CAO number. Registration costs €130.
Medical schools overseas
If you decide, after doing some research, that medicine may not be right for you or that you are not capable of the academic requirements, there are various similar subjects that may be more suitable and are worth considering.
Equally rewarding and worthy professions include: dentistry, pharmacology, nursing, physiotherapy, optometry and veterinary.
It is important to realise that dentistry should not be viewed as an easier alternative to medicine. Dentistry is often more demanding academically and entry to dental college generally requires higher A level results. Job prospects for newly qualified dentists are very good.
Whereas a doctor will only specialise in one area of medicine or type of treatment, a dentist is responsible for examination, diagnosis, treatment, surgery, X-ray and post-treatment patient care. Dentistry is not just drilling teeth; it also includes oral hygiene, dental reconstruction and dietary advice or even primary care such as diagnosing oral cancers or identifying cases of child neglect.
Most qualified dentists are self-employed and work as a General Dentist Practitioner privately, for the NHS or both. It is important to keep up-to-date with NHS changes that affect the way dental practices run.
If you wish to apply for a degree in dentistry then assume that you will get an AAA offer. Most courses require you to take both Biology and Chemistry A level.
If you have retaken your A levels you are highly unlikely to obtain a place to study dentistry, unless you have genuine and extenuating circumstances and you have applied previously and held an offer from that university.
Again, veterinary science is definitely not an easier option than medicine. There are six schools offering veterinary medicine in England and two in Scotland, so competition is tough.
As with medicine, the opportunities for specialisation within the career are very wide. There are microbiologists, parasitologists, pathologists, surgeons and equine specialists, for example. You will, however, have the opportunity to treat many more species than a medical doctor does and so the training is even more gruelling and rigorous.
Types of employment:
- Department of the Environment, Food and Rural Affairs (DEFRA)
- An animal charity such as the RSPCA
- A private practice.
Each is in itself varied and increasingly specialised.
Veterinary medicine is a physically tough and dangerous career as many animals are not keen on veterinary treatment! There is a huge demand for veterinary doctors willing to work in large-animal practice in agriculture. Many vet graduates choose careers in small animal practices in urban areas as these are less dangerous and physically hard and generally offer a more convenient lifestyle. This has led to a surplus of small animal vets in England.
Dealing with animals does not isolate a vet from the need to be able to communicate effectively with humans. Informing a person that his or her pet is too sick for economical treatment requires as much sensitivity and empathy as dealing with sick people. Equally difficult is telling a farmer that you may need to cull all of his livestock to contain the outbreak of a disease, hence seriously compromising his livelihood and only source of income.
Veterinary medicine has arguably the most demanding entry requirements of all courses. Students should aim to study Chemistry and Biology and another science. Most applicants to veterinary medicine will probably have taken four A levels and secured A grades in each.
If you have taken or are considering taking retakes at A level then you almost certainly will not be successful in getting into Vet School. You are also highly unlikely to find any Vet courses listed in clearing.
Optometry is a healthcare profession dealing with eyes and the visual system. It requires a level of commitment similar to medicine. The degree involves a BSc followed by clinical training and so is similar to a medical degree. An optometrist is concerned with preserving or restoring vision to people to help them live fulfilling, unhindered lives. The loss or depletion of good visual activity can be an extremely debilitating disorder.
The allure of a degree in optometry might be driven by a desire to become a specialist in a highly intricate piece of anatomy. You should certainly have a strong interest in the sciences, in particular practical aspects, as problem analysis and problem solving are frequent features of an optometrist’s daily work.
The optometrist, like a GP, is a healthcare professional and as such should possess good interpersonal and communication skills. Additionally, you will require a good degree of business acumen as optometrists are generally managers of their own business and appoint their own staff.
Being a physiotherapist is not all about rushing onto the pitch during a premiership football match. Although there may be an opportunity to work with professional sports people, physiotherapists are also employed in industry and private practices. However, the majority of chartered physiotherapists work for the NHS.
You will be responsible for treating patients with a wide range of diseases, both communicable and non-communicable. Physiotherapy is also a vital part of the rehabilitation process of patients who have:
- Suffered accidents
- Undergone surgery
- Been confined to bed for long periods of time.
If you opt to work for the NHS you will find yourself part of a team that may include osteopaths, occupational therapists, prosthetists as well as other hospital staff such as doctors and nurses. Subsequently, you must be a good team member with excellent communication skills. You should have a keen interest in human physiology and in practical science skills. Physiotherapy is a ‘hands on’ approach to healthcare that incorporates a wide range of mechanical equipment in addition to your own hands.
Physiotherapy is extremely competitive and hugely oversubscribed. Although entry requirements are lower than those for medicine, only candidates expressing a real desire to become a physiotherapist will be considered. Ashbourne can help you assess the strengths of your application and help you overcome your weaknesses. Work experience is vital if you intend to be taken seriously.
A relevant Biological Science (Biology, Human Biology or in some cases Sports Studies) will almost always be required to full A level. Another science subject is also recommended.
Pharmacy and Pharmacology
If you are interested in a rigorous and demanding medical sciences degree, then Pharmacy may be for you. Pharmacists are responsible for advising patients of appropriate medications and hence carry a large degree of responsibility. You will be responsible for preparing and dispensing drugs for sale and for counter prescriptions.
You will lead a team of assistants and be required to work lengthy hours in busy and often stressful situations. Pharmacists also work in hospitals. The course is demanding and popular; hence, entry requirements are often high.
A level Chemistry and at least one other science (Biology preferred) will be prerequisite.
Nurses make up the largest staff group in the NHS and are critical to all areas of healthcare from accident and emergency, GP surgeries and on the ward to clinics, schools and patients’ homes. The demands of nursing courses are as heavy as for doctors but it can be an extremely rewarding career.
Specialist ward nurses may be able to diagnose patients, prescribe and dispense some medicines, refer patients to other specialists and carry out nearly all the duties of a doctor. This has been reflected in improved pay scales and conditions for such nurses.
Nursing is not as highly academically demanding as medicine at A level: two A levels and an AS level at least are required. Biology and one other science, preferably Chemistry, are needed; the most important requirement is a high level of commitment.
Routes into nursing:
- The degree programme through university study
- Part-time apprenticeship degree programme over four years
- Training to become a nurse
Biomedical Science (BMS) is often seen as either a backdoor to medicine or as ‘medicine-lite’. However, BMS is very demanding as students will need to master a greater depth of academic knowledge than medical students whilst remaining familiar with clinical practice and medical applications.
BMS contains a high proportion of chemistry and biochemistry and incorporates a substantial amount of independent academic research. Most BMS degrees last for four years including a six-month or year-long research project.
BMS graduates usually continue in academic or industrial research in a university or pharmaceutical company; candidates should consider carefully whether this is the career path they wish to pursue.
If you are still interested in a degree in healthcare or medical science but do not feel any of the options above are suitable for you, there are other alternatives to choose from.
The tutors at Ashbourne will advise you on the suitability of any of the courses below as well as help you to choose the most appropriate institution:
Undertaking a medical degree is likely to be a big financial commitment, particularly if you intend to also study a foundation year or an intercalated degree course.
Loans and fees vary but typically a three-year degree course outside of London can incur loan fees of £35,000 to £60,000.
Your expenses are likely to be:
- Tuition fees
- Living expenses for up to 6 years
- Books and equipment for your studies
- Electives if you choose to go abroad.
It is important to remember, however, that there are many forms of financial support available to you and also that you will be entering a well-paid and secure career.
Be aware that there are different rules for funding depending on your nationality including English, Scottish, Irish or Welsh.
Fee loans of up to £9,250 per year are available to help cover your tuition costs during your time at university. Tuition fees vary depending on your course and where you study. Scottish students applying to study in Scotland do not pay tuition fees at all. Welsh students can apply for a tuition fee grant (that you do not have to pay back) to study in the UK. Northern Irish students only pay up to £3,925 of their fees if studying in Northern Ireland. You do not pay back any fees until you graduate and start earning more than £21,000 (£16,910 for Scottish and £17,495 for Northern Irish loans).
These are available to all students to cover living costs and are administered by the Student Loans Company. These are partly means tested and vary according to where you live and study, and your personal circumstances.
NHS England pays tuition fees and provides bursaries to students in years 5 and 6 of non-graduate entry medical courses and in years 2-4 of graduate entry courses.
Again eligibility and entitlement criteria are complex and vary according to personal circumstances.
Many universities offer grants and bursaries especially to students under severe financial hardship. There are a number of scholarships that can be applied for, but often these are specifically for graduate students. Check individual university websites for these.
Other sources of income
Other sources of income to fund your studies include:
- Part-time work (time may be limited on a medical degree)
- Parental contribution
- Local charities
- Access to Learning Fund
- Bank overdrafts (graduate accounts)
- Professional study loans/professional trainee loan schemes.
A selection of additional sources of information on funding:
About the NHS
The National Health Service (NHS) was formed in 1948 by Clement Attlee’s post-war Labour government. It effectively nationalised healthcare, with financing provided by central taxation. The NHS is currently one of the largest employers in the world, with more than 1.5 million people.
The NHS now provides the majority of healthcare in England and has become an integral part of British society, culture and everyday life. Find out more about NHS England.
The private sector
Private healthcare exists in parallel to the NHS and is paid for mostly by private insurance. This is used only by a small percentage of the population and as a top-up to NHS services.
Organisation and funding
NHS services are largely ‘free at the point of use’ and paid for by taxes. The estimated budget for the NHS for 2015/16 was £116. 4 billion. Responsibility for the NHS lies with the government – the Department of Health (DH).
The DH is led by the Secretary of State and includes government ministers whose job it is to provide strategic leadership to the NHS and social care organisations.
History and development
The NHS was established in 1948 by Clement Attlee’s Labour government based on the proposals of the Beveridge Report. It is based on the idea that good healthcare should be available to all regardless of wealth.
The 1980s saw the introduction of modern management processes in the NHS to replace the previous system of consensus management (i.e. general managers were appointed and clinicians became more involved in management).
The introduction of the ‘internal market’
Margaret Thatcher ordered a review of the NHS in 1988 and this outlined the introduction of the ‘internal market’ which changed the structure and organisation of the health services.
In 1990 the National Health Service and Community Care Act defined this ‘internal market’ as a system whereby local Health Authorities ceased to run hospitals but commissioned care from their own or other authorities’ hospitals for the local population. Certain GPs became ‘fund holders’ and were able to purchase care for their patients.
Hospitals as healthcare providers became independent Hospital Trusts competing to provide care. The rationale was that competition improves standards of care, but this system has increased regional differences in care; this is often referred to as the ‘postcode lottery’.
These changes were condemned by the Labour Party, which claimed that the Conservative intention was to privatise the Health Service. This was a major feature of the Labour Party election campaign in 1997.
The Blair years
The incoming government of Tony Blair in 1997 stated an intention to abandon the principles of competition and the ‘internal market’ and abolish fund holding, but this was actually re-introduced as part of Blair’s ongoing reforms to modernise the NHS.
After the NHS struggled to cope with a winter hospital crisis in 2000, Labour responded with an ambitious ‘NHS Plan’ that included principles of competition and market, massively increased investment and expansion of the ‘private finance initiative’ or PFI.
The PFI is a way of building hospitals and obtaining some services through private enterprise. In an attempt to create uniform standards of care a vast array of performance targets and national guidelines were drawn up. However the NHS is so complex that it has proved difficult to set these guidelines and targets in a way that promotes a fair service to patients. It is argued that hospitals built through PFI are:
- More expensive to build and operate than if they were publicly funded
- Result in staff losses
- Result in a reduction in the number of patient beds.
The advent of Primary Care Trusts
The healthcare services provided by the NHS are divided into primary, secondary, elective and emergency care.
In 2000, Primary Care Trusts were created to purchase primary healthcare and public health in a specific geographical area. They used to spend around 80% of the NHS budget but stopped providing services directly in 2011 and were abolished altogether in 2013 as a result of the the Health and Social Care Act 2012. Primary care is now provided by Clinical Commissioning Groups (CCGs).
The creation of Foundation Trusts
In 2004 Foundation Trusts were created with the aim of giving certain Hospital Trusts freedom from the control of central government and making them instead accountable to local people. In addition, ‘extended patient choice’ was introduced in 2004 to improve standards further through competition.
Reforms during this period of Labour government included:
- Laying down of detailed service standards
- Strict financial budgeting
- Revised job specifications
- Closure of surplus facilities
- Emphasis on rigorous clinical and corporate governance
- Medical training restructuring (foundation training)
- New services to manage demand (e.g. NHS Direct, later replace by NHS 111)
- Staff reforms – harmonised pay and career progression
- NICE – National Institute for Health and Care and Excellence.
The NHS encountered significant IT problems with innovations accompanying the Blair reforms. The NHS’s National Programme for IT (NPfIT) was scrapped in favour of a more modest programme in September 2009 as it had run behind schedule and above budget with friction between the government and the programme contractors.
Patient information security remains a source of concern for medical practitioners and patients.
Socially directive policies
The NHS has also been required to take on socially ‘directive’ policies (e.g. with respect to obesity and smoking).
A number of ongoing factors continue to drive reforms:
- Rising costs of medical technology and medicines
- A desire to increase standards and ‘patient choice’
- An ageing population
- A desire to contain government expenditure.
Prior to the election in 2010 the Conservatives promised to avoid ‘massive structural reorganisation’. However the then health secretary Andrew Lansley nonetheless drew up the radical Health and Social Care Bill which aimed to give spending power back to GPs, sideline primary care trusts, give the private sector a bigger role and dismantle much of the architecture of regulation and targets introduced by the previous Labour government.
In June 2011 the government published proposed amendments to the Health and Social Care Bill following a ‘listening exercise’ on its NHS reforms during which they were widely criticised by the medical profession and unions such as UNISON.
In March 2012 the Health and Social Care Act was passed. It was the most radical restructuring of the NHS since its creation in 1948, abolishing Primary Care Trusts and Strategic Health Authorities, now replaced by Clinical Commissioning Groups. Those are clinically led groups composed of all the GP groups of one particular geographical area. GPs are in charge of ‘commissioning’, buying, healthcare services such as hospital care and emergency care. The Health and Social Care Act has been criticised as an attempt to privatise the NHS.
Organisation of the NHS
People cannot plan for emergency events and there are various first ports of call:
- Primary care out-of-hours services – telephone or face-to-face advice
- NHS walk-in centres – treatment for minor conditions with no appointment
- Ambulance services – trained paramedics with advanced emergency care skills
- Hospital A&E – emergency medical care.
General practitioners (GPs) diagnose and treat a wide range of health problems in the local community. They and their teams also:
- Provide health education and advice on things like smoking and diet
- Run clinics
- Give vaccinations
- Carry out simple surgical operations.
Doctors usually work in a team with nurses, health visitors and midwives, as well as a range of other health professionals such as physiotherapists and occupational therapists.
If a GP cannot deal with your problem, they will refer you to a hospital for tests, treatment or to see a consultant with specialist knowledge.
Social Care Services
These look after the health and welfare of the population. The main groups include:
- Children of families under stress
- People with disabilities
- People with emotional or psychological difficulties
- People with financial or housing problems
- Older people who need help with daily living activities.
Social care services may be offered in hospitals or health centres, in educational settings, community groups, residential homes, advice centres or even in people’s own homes.
These services are normally run by local councils, and are sometimes run in conjunction with local NHS providers and organisations.
The principal fund holders in the NHS are the Clinical Commissioning Groups (CCGs).
The CCGs receive a budget from the Department of Health depending on their population and specific local needs. (They are required to ‘break even’, although this is often impossible to do.) CCGs use this budget to commission healthcare for their area.
Except for set charges applying to most adults for prescriptions, optician services and dentistry, the NHS is free for patients at the point of use. The current prescription charge for medicines in England is £8.20 per item (certain groups are exempt).
The rising costs of some medicines, especially cancer treatments, mean that prescriptions can present a heavy burden to the CCGs. This has led to disputes in certain cases (e.g. Herceptin) as to whether drugs should be prescribed.
The role of NICE (established in May 2008) is to assess new treatments, drugs and technology to develop clinical guidelines that balance the costs to the taxpayer and the benefits to patients.
The NHS does provide some facilities and centrally employed healthcare professionals in areas where there is inadequate provision by self-employed professionals.
The NHS has frequently been a target of criticism over the years regarding:
- Length of waiting lists for consultations, diagnostics and treatment
- Levels of antibiotic-resistant bacteria in hospitals (e.g. MRSA and Clostridium difficile)
- Problems with the NHS IT update
- Decreasing availability of NHS dentistry
- Lack of availability of some treatments due to their cost ineffectiveness
- Hospitals and trusts running into debt.
Some of these have resulted in people seeking medical care overseas (‘health tourists’).
Further reading on the NHS
General Medical Council (GMC)
The GMC registers doctors to practise medicine in the UK. Their purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.
British Medical Association (BMA)
The BMA is a voluntary professional association of doctors and is an independent trade union. It keeps doctors informed of medical issues and publishes the British Medical Journal.
Medical Research Council (MRC)
Distributes taxpayers’ money to medical researchers. Promotes research in all areas of medicine and medicine-related technologies.
NHS Constitution for England
Sets out standards and rights which UK citizens can expect from the NHS. This includes complaints procedures for substandard and non-professional treatment.
The Medical Defence Unit (MDU)
The MDU is a mutual, non-profit organisation that defends the professional reputation of its members when their clinical performance is called into question. The MDU may pay legal costs for its members and it may also pay compensation to patients who have been harmed by medical negligence during their treatment.
The Medical Protection Society
This is a not-for-profit organisation offering support to health professionals with the legal and ethical problems that arise from their professional practice.